Visual charting method for creating electronic medical documents

ABSTRACT

A method of creating medical documentation uses selection of images representing synonyms for complex medical concepts. The images can be of two types, one corresponding to a parameter or Key in a Key/Value pair and the other corresponding to possible values of the selected parameter or Key. The user first selects an image or portion thereof corresponding to the parameter they wish to record observations, such as the heart or a valve of the heart. A set of images representing possible values of the parameter is then displayed e.g., images representing possible murmurs the selected valve may have. The user selects the image representing the value corresponding to the observation of the patient. A document is created by recording either the Key/Value image pairs or, alternative, text representing the synonyms for the images. Other methods of recording the document are possible, such as instantiating a set of class objects.

CROSS-REFERENCE TO RELATED APPLICATION

The present application is a U.S. continuation patent application of,and claims priority under 35 U.S.C. § 120 to, U.S. non-provisionalpatent application Ser. No. 13/621,087, titled “Visual Charting Methodfor Creating Electronic Medical Documents” filed Dec. 31, 2013, and U.S.non-provisional patent application Ser. No. 12/930,132, titled “VisualCharting Method for Creating Electronic Medical Documents” filed Dec.28, 2010, which non-provisional patent application published as U.S.patent application publication no. 2012/0166219, which patentapplication and any patent application publications thereof areincorporated by reference herein.

COPYRIGHT STATEMENT

All of the material in this patent document is subject to copyrightprotection under the copyright laws of the United States and othercountries. The copyright owner has no objection to the facsimilereproduction by anyone of the patent document or the patent disclosure,as it appears in official governmental records but, otherwise, all othercopyright rights whatsoever are reserved.

BACKGROUND OF THE INVENTION 1. Field

This invention relates generally to the field of computerized systemsfor storing and creating electronic records, and in particular tomethods and systems for creating medical documentation regarding apatient.

2. Description of Related Art

In the medical arena, hand written patient record keeping systems haveevolved through many years of careful refinement and enhancement intosystems which maintain a detailed manual record of medical informationconcerning each patient. To meet the needs of different hospitalentities (such as doctors, nurses, pharmacy, accounting, laboratory,etc.) a manual record keeping system often requires that one piece ofinformation be entered into multiple records. In addition it oftenrequires that the same information that has not changed from visit tovisit (such as family/social history, allergies, immunization status) bere-asked of the patient and redocumented in the current record. Incertain instances, such as in the Emergency Department, this informationmay be asked and recorded as many as three separate times (on the TriageNote; the main ED record; and MD documentation) leaving the patient towonder if there is any communication between healthcare providers andfrustrating those healthcare providers who must fill out more and morepaperwork. If the patient is admitted, this same information is thenasked and recorded again by the admitting nurse and attending physician.

In a typical manual patient record keeping system a patient chart,usually in the form of a notebook, is maintained at the nursing stationfor each patient. The notebook is divided into a plurality of individualtabbed sections, such as Physicians Orders, Kardex, Nursing Care Plan,Nursing Assessment, and Laboratory. Each of the above sections isfurther subdivided into a number of forms. The forms are those which areappropriate to the individual patient and/or such patient's physician.For example, within the Laboratory section there may appear forms forchemistry, hematology, blood gas, and microbiology.

In addition, a “flowsheet” chart is usually kept at the patient'sbedside, particularly in a critical care environment. On the “flowsheet”chart there are individual areas for medication records, vital signs,intake/output, laboratory results, and other categories which aredependent upon the patient's affliction, such as intravenous (IV) drips.

Referring in particular to nursing functions, annotations to chartsand/or nursing progress notes are made manually. Typically, briefnotations are jotted down in various places throughout a shift. Sometimeduring the shift, typically at the end, the nurse makes a full notationinto the nursing progress notes based on the brief notations orremembered items. This process can be very inefficient since notationsmay be forgotten or not copied appropriately. In particular,documentation and entry of physician orders, prescriptions and otheractivity has been viewed as two separate activities or steps, one stepcompleting the documentation and a second step of entry of the order orprescription in the medical records of the patient.

The need for more efficiency of workflow and coordination betweenmultiple departments and healthcare providers in a hospital environmenthas led to the advent of computerized medical records applications.Medical records management systems are known in the art and include thesystems disclosed in the following U.S. Pat. Nos. 5,325,478; 5,247,611;5,077,666; 5,072,383 and 5,253,362 all assigned to the assignee of thisinvention, and have been commercialized by the Assignee of thisinvention and others. Other background prior art of interest includesCantlin et al., US 2006/0173858; Kim et al. U.S. Pat. No. 7,793,217;Britton et al. U.S. 2004/0015778 and Goede et al. U.S. Pat. No.7,453,472.

Some software applications for creating medical documentation require auser to type in textual entries representing observations of a patient.Often, such observations may encompass complex medical concepts. As oneexample, in the context of a examination of a cardiac patient, theobservations may include observations about particular heart murmurpatterns present in the aortic, tricuspid, mitral and pulmonary valves.Medical documentation (e.g., a structured note) is created by thephysician that documents all such observations. A text-based approach tocreating such documentation (i.e., typing in all of the clinicalobservations) is time consuming and inefficient.

SUMMARY OF THE INVENTION

This invention meets a long-felt need in the art for a method forcreating medical documentation more quickly than traditional text-basedapproaches. In particular, this invention provides a visual, symbolicapproach to creating documents, referred to herein as “visual charting.”In visual charting, complex medical concepts are presented on a userinterface display as symbols which are selected by the physician as partof a medical documentation creation process. The symbols are, inessence, synonyms for a textual description of the complex medicalconcept. By means of selection of symbols, and in preferred embodimentsa sequence of such symbols, the visual charting method preserves thecomplexity and nuance in the content of a medical document thattext-based approaches provide, while substantially reducing the amountof time it takes the practitioner to create the documentation. Inessence, medical charting concepts requiring the recording of detailedinformation can be represented by specific images, the selection ofwhich allowing medical documentation to be created in a more efficientmanner.

The features of this invention provide a number of additionaladvantages, and solve problems heretofore present in the art. The imagescan serve as synonyms for concepts which might require detaileddescriptions (in text). Visual charting can conserve space on forms andreduce the need for scrolling a form or navigating to multiple forms,further adding efficiencies to the process. The images in the visualcharting approach can be converted into specific properties of classobjects in an object-oriented programming environment, which canpopulate or be populated by a Key/Value pair relational data constructusing a database or XML (extensible markup language) or other text-basedrepresentation of object properties. Visual charting further improvesthe ability to efficiently chart on small platforms such as SmartPhones, Pocket pes, iPhones, iPads and similar devices. Additionally,the visual charting methods provides the ability to chart (i.e., createdocumentation) without a keyboard, i.e., without entering any text atall.

The invention will be described below in several different aspects. Inone aspect, a method of creating a medical document using a computingdevice (for example a desktop workstation, smart phone, tablet computer,or the like) having a display, is described. The method includes thesteps of: (a) presenting on the display an image representing a medicalconcept, such as an organ or organ system of a human or animal body; (b)enabling selection of a parameter associated with the medical concept bymeans of selecting a portion of the image corresponding to theparameter; (c) responsive to the selecting in step (b), presenting onthe display a set of images comprising possible values associated withselected parameter; (d) enabling selection one of the images in the setof images presented in step (c); and (e) constructing a medical documentbased on the selecting in steps (b) and step (d) and storing the medicaldocument in a computer system.

The images selected in steps (b) and (d) are interchangeable with (i.e.,synonyms of) a language description of the selected parameter and theselected value of the selected parameter. The selection of the parameterin step (b) may be accomplished using visual methods, such as selecting(e.g., by touch or mouse click) a portion image of medical concept imagerepresenting the parameter. Examples of this method will be describedbelow in further detail in conjunction with visual charting of a cardiacpatient, in which the image representing the medical concept is an imageof the heart, the parameter selected from the image is one of the heartvalves, and the selection of one of the heart valves causes display of aset of images associated with murmurs (or other possible values) of theselected heart valve.

The method can be performed iteratively in which additional parametersare selected and visual charting is used to select values for additionalparameters. Thus, the method may include the repeating steps (b), (c),(d) and (e), wherein the repeated step (b) comprises the selection of adifferent parameter associated with the medical concept. In this mannera medical document consisting of multiple parameter/value pairs can becreated.

To facilitate ease of use and understanding of the images, the methodmay further include the steps of displaying on the display the languagetextual description or synonym for each of the images selected in steps(b) and (d).

In one possible embodiment, the medical document created using themethod can be saved as a text file in a predetermined format, such as anXML format. Additionally, the medical document can be saved as aKey/Value pair in a database, the Key corresponding to the selection instep (b) (either in the form of text or in the form of data representingthe portion of the image selected) and the Value corresponding to theselection in step (d) (again, either as image or its textual synonym).Alternatively, the selections in step (b) and (d) can be saved asproperties of a class object in a object-oriented system.

The visual charting system can be used with the charting of virtuallyany medical concept which lends itself to medical note writing in termsof parameter and value pairs. For example, the medical concept that isdisplayed can be a organ or organ system such as the heart, thecirculatory system, the respiratory system, the kidneys, the digestivesystem, the skeletal system and the central nervous system.

In another aspect, the invention can be considered an improvement to acomputing device used for medical document creation. The computingdevice can take the form of a desktop workstation, smart phone, tabletcomputer, or the like. The computing device has a display, and memorystoring instructions for execution by a processing unit in the device,all of which is conventional. The improvement takes the form of a visualcharting application coded as a set of instructions executed by theprocessing unit in the device, wherein creation of a medical document bythe visual charting application is performed by selection of images orportions thereof presented on the display of the computing device, theimages including images of a first type acting as a synonym for amedical parameter and images of a second type of acting as synonyms ofvalues of the medical parameter, wherein a selection by the user of animage of the first type causing a display of a set of images of thesecond type to be presented on the display.

Since the images are synonyms for a textual description, the selectionsof the user can be saved as either textual descriptions or alternativeas a set or sequence of images. For example the images can be selectedas “key/value” pairs or “parameter/charted observation” pairs usingconcepts configured with primary keys of a relational database toachieve the same data relationships that are created when text-basedlanguage forms are used to capture information.

In still another aspect, a method of creating electronic medicaldocuments is described using visual charting. The method includes thesteps of: (a) creating a data structure with persistent data comprisingdescriptive information associated with a plurality images to bepresented on a medical documentation template displayed on a computingdevice, the images representing medical concepts such as an organ ororgan system of a human or animal body; (b) rendering one of the imagesin the medical documentation template on the computing device (e.g., animage of the heart); (c) receiving a user selection on the computingdevice of a parameter of the medical concept by selecting a feature inthe image corresponding to the parameter (e.g. selecting a portion ofthe heart image corresponding to one of the heart valves); (c)responsively displaying on the display a set of images associated withvalues of the selected parameter (e.g. images of possible murmurs ortypes of murmurs of the selected heart valve); (d) receiving a selectionof one of the images in the set of images; and (e) creating a medicaldocument reflecting the selection of the images and storing the medicaldocument in a database.

BRIEF DESCRIPTION OF THE DRAWINGS

Exemplary embodiments are illustrated in referenced figures of thedrawings. It is intended that the embodiments and figures disclosedherein are to be considered illustrative, rather than restrictive.

FIG. 1 is a block diagram of a computer electronic medical recordssystem implemented in a medical facility such as a hospital;

FIG. 2 is a schematic representation of a portion of the clinicaldatabase of FIG. 1, showing an electronic patient record for patient X,with the record including a number of fields or categories, eachassociated with a different portion of the database record. Thesecategories, which may be user or customer defined, include categoriessuch as Orders, Documents, Prescriptions, Allergies and still others.The illustration of FIG. 1 shows a relational database implementationwherein data is organized in rows and columns. However, the use ofobject oriented database design in which data is stored as objects is analternative implementation;

FIG. 2A is a flow chart showing a process of creating a visual chartingcapability in the medical records system of FIG. 1 and using it tocreate clinical documentation which can be stored in the database ofFIG. 2; and

FIGS. 3-11 are a series of screen shots of a workstation, smart phone,or other computing device used by a medical practitioner showing theprocess of creating a medical document concerning a patient using avisual charting method.

DETAILED DESCRIPTION

Visual charting is a form of medical note writing that incorporatesimages as synonyms for Key/Value pairs. The process of visual chartingresults in the development of structured information for an electronicmedical record that can be stored or rendered as either a “language”(i.e., textual) medical note or as an image medical note. Some of theimages used in visual charting represent a description of a “key”, alsoknown as a parameter or a question regarding a medical concept (e.g.,organ or organ system). Other types of images used in visual chartingrepresent an observed finding regarding the parameter, also known as acharted observation or a value or an answer. Together, the images ofboth the parameter and the value represent unique combinations withinthe electronic medical record, commonly known as key/value pairs.

The result of the visual charting method is the creation of a medicaldocument, which may take the form of a textual note, as well as thestorage of key/value pairs within the database (e.g., in an electronicmedical record). The result can also be stored or represented in otherforms, such as an XML (extensible markup language) document representingthe information. The concept of visual image synonyms representing thedefinition keys of structured note writing make the imagesinterchangeable with a textual description of the concept captured orconveyed by the image selected. Alternatively, the result of visualcharting can be saved as properties of a class object in aobject-oriented system.

The visual charting methods of this disclosure will be described indetail later in this document in conjunction with FIGS. 2A-11. In brief,the methods involve presenting on the display of a computing device animage representing a medical concept, such as an organ or organ systemof a human or animal body. From that image, a body part or sub-region ofthe image is selected which represents selection of a parameter or setof parameters related to the body part or region. In response to thatselection, the user is presented with a display of a set of imagescomprising possible values associated with selected parameter. In otherwords, the user is presented with multiple images that can be selectedto describe the appearance, or the physical exam or verbal answers toquestions related to the body part or region, i.e., values associatedwith the selected parameter. A medical document is then constructedbased on the selections of the parameter and values, and the medicaldocument is stored in a computer system. For example, as the userselects the images during visual charting, the computer system isbuilding an XML representation of the textual synonyms of the selectedimages. The medical document can be represented in other equivalentmanners, such as a textual representation of the questions and answersassociated with the images, or as a class object properties and valuesrepresenting a structured or non-structured set of key/value pairs orquestion/answer pairs.

A description of one possible hardware and software environment in whichthe invention can be practiced will be described next. In the followingsection an example of visual charting will be provided.

A. Hardware and Software Environment of Invention

Referring now to FIG. 1, a representative and non-limiting example of anenvironment in which visual charting can be practiced is shown in blockdiagram format. In particular, FIG. 1 depicts a computerized medicalrecords system 10 that is used by clinicians (physicians, nurses andother medical personnel) and hospital administration staff. The systemis shown installed in a medical facility 12 indicated in dashed lines.The medical facility may for example be a hospital, nursing home,clinic, or other medical enterprise. The details on the medicalenterprise and type of health care services it may render to patientsare not particularly important. One possible application of thisinvention is in the hospital environment, and therefore the followingdescription will be made in conjunction with a hospital, but again thisis only by way of non-limiting example.

The medical records system 10 includes a plurality of distributedcomputing devices or workstations, e.g., client computers 14, a centraldatabase server 16, and a database 18 storing, among other thingselectronic patient records including medical documentation created usingthe visual charting methods of this disclosure. Clinical data can beextracted from the database 18 and loaded into an analytics database 18Afor data analysis and reporting in the manner described in US PatentApplication Publication No. 2009/0024414. The workstations 14 could befor example general purpose computers with a processing unit andgraphical display unit and mouse or other pointing device for section ofimages using the methods of this disclosure. The workstations 14 couldalso be portable computing devices such as hand-held computer, smartphone or tablet PC shown at 17 having a display 19 in the lower left ofFIG. 1. The portable computing device communicates with the network 32via a wireless base station 15 using a suitable and knowntelecommunication methods (e.g., Bluetooth, WiMax or cellular telephonenetwork). The workstations 14 include a memory storing an interactive,client-server based patient documentation application that is executedby the processor in the workstation. The application provides userinterface tools in the form of graphical screen displays which allow theuser access the electronic patient records stored in the database andcreate clinical documentation regarding a patient being treated at thefacility 12 using the visual charting methods described in FIGS. 2A-11.

As shown in FIG. 1, the facility 12 may include an Intensive Care Unit20 with a workstation 14, which may be used by ICU physicians and ICUnurses to access patient records and input orders, write prescriptions,view patient allergies, and create medical documentation. The facilitymay also include one or more laboratories 22, each of which may includea workstation. Lab personnel may input test results into the patientrecord stored in the database 18. The facility may also include anEmergency Room (ER) 24, where a workstation 14 is provided for ERclinicians to records and input orders, write prescriptions, viewpatient allergies, note significant events and chief complaints, etc. ofthe patients and input them into the electronic patient record stored inthe database 18. The facility may also have a number of patient roomsand provide nurses stations (NS) 26 on each floor, each of which has aworkstation 14. Additionally, physicians' offices 28 may also includeworkstations 14, in the form of personal computers. The facility 12 mayhave other operations, clinics, departments, etc. as indicated at 30,each of which may be provided with additional workstations. Theworkstation are networked on a local area network 32 wherein all of theworkstations may exchange data with the central database server 16 andthereby access the patient records stored in the database 18 and writedocumentation and orders, prescriptions, and other information to thedatabase 18.

The network 32 may include a router (not shown) providing a connectionto an internet service provider (ISP) 40 providing access to an externalwide area internet protocol network 42 such as the Internet 42. Aworkstation 14A may be coupled to the enterprise network 32 via the ISP40 whereby a clinician authorized to access patient records in thedatabase 12 may do so via the Internet 42, ISP 40 network access serverand local area network 32. Thus, a workstation 14, 14A creating patientdocumentation need not necessarily physically reside on the network 32or be physically located within or at the enterprise 12.

The medical records system 10 allows clinicians to create new medicaldocumentation and store such documentation in the database 18, as wellas access patient records in a clinical database 18. The system 10 maytake the form of a hospital medical records information system, and suchsystems are generally known in the art and commercially available fromAllscripts Health Care Solutions, Inc., and others. The preferredembodiment of such a system provides clinicians information they need,when and where they need it—at the point of care, e.g., in the ER or atthe nursing stations 26, in the offices 28, via Smart Phones or portablePCs 17, and even at home via a computer 14A and the Internet 42.

A schematic representation of the database 18 is shown in FIG. 2. Thedatabase includes a multitude of electronic patient records 50, 52 eachcomprising rows and columns of data. A first field 54 is shown directedto patient information, such as name, address, insurance carrier, dateof birth, etc.

A second field 56 contains orders for the patient. The orders aredetermined by health care personnel treating the patient. Each row inthe orders field 56 may constitute a specific order, and the variouscolumns in the row devoted to different aspects of the order, such asthe entering physician's name, the type of order, the date it wasplaced, etc.

A third field 58 is directed to documents (i.e., medical documentation)entered by a physician or nurse. Each row may represent specificinstances of documentation created by a user.

A fourth field 60 contains prescription medications ordered for thepatient. A fifth field 62 contains data of all the patient's allergies.Other fields 64 are also present, and may include fields devoted tosignificant events, health issues, care providers and others. The nameof the categories in the electronic patient record, and the number ofcategories is not particularly important and may vary depending on theenvironment and the choices made by a system administrator.

B. Visual Charting Example

Visual Charting represents the development of medical charting toolsthat incorporate images as synonyms for interchangeable values inKey/Value pairs in a data structure or properties of class objectsrepresenting medical concepts, such as a description of a cardiacexamination or any other body area or organ system. The image of theanatomic representation of the organ or the finding related to the organsystem correlate to a primary Key in an electronic medical record torepresent the concepts. The concepts represented by the images areinterchangeable with the language descriptions of the same concept suchthat the concepts could be represented in a medical note as the image orthe language description. The persistent data representing the medicalnote could be held in a database in FIG. 2 in a variety of forms, forexample a text based representation of a data such as XML.

When computing with these forms and collecting the medical data theorgan systems and descriptions are represented as class objects withproperties (or XML) that can be populated by the medical worker througha forms system, an electronic medical record database or a text baseddata structure such as XML. The medical charting tool can be defaultedto normal images representing “normal status” in medical language. Themedical language is interchangeable with the images and is representedby unique keys which could be defined in a proprietary language or adistributed standard such as SNOMED CT. Computer code handles thedefinition of the class objects and the assignment of the class propertyvalues to the class objects, the reading and writing of XML, the readingand writing to the database structures and the rendering of the userinterface. This technology will be used any type of computer workstationto include the smart phone, iPhone, iPad, laptop, tablet, fixedworkstation of any other electronic device that is used to interact as auser interface for the electronic medical record.

FIG. 2A shows how a visual charting system is created and operates. Inbox 70, configuration software creates in the database persistent datadefining images for medical documentation templates, and the textualsynonyms associated with such images. The configuration software couldalternatively create XML documents with such data. Such database (or XMLdocument) is represented at 72. The system includes software coderepresented at 74 which reads and writes data and renders forms(document templates) on the displays of the computing device used forvisual charting. Such forms include the images to represent complexmedical concepts and values (charted observations) as described hereinusing class objects or XML, depending on the implementation. Userinterface software 78 resident on the computing device displays theimages to represent unique concepts for Keys and Values to createKey/Value pairs, and the user interacts with this software to createmedical documentation. As a result of the user interacting with thesoftware 78 during the visual charting, resulting medical documents 76are created and stored in the database 18 of FI G. 1, which can be ineither text or image format, or in some other format.

An example of the use of visual charting will be now described inconjunction with FIGS. 3-11. The display 100 of a computing device(workstation 14, or portable computer 17 of FIG. 1) includes a text box102 in which textual synonyms for images displayed on the display andselected by the user is set forth for the convenience of the user. Theworkstation includes a pointing device such as mouse or touch sensitivescreen which controls a cursor 104 for making selection of images orportions of the image. In this example, the display 100 shows two views110 and 112 of a human body and in particular the heart 108.

In general, the user interface of FIG. 3 displays an image or images(110, 112 108) which can be used to select a specific medical concept(key) and a specific value for the concept. In this example the user iscontrolling the cursor 104 to point to the trachea as part of theexamination of the neck. The first click of the mouse may set the Key orParameter as the unique concept of neck anatomic part “Trachea,” whichis represented with the configuration of the database as a specificparameter or observation (Key). The next click over the midline of theneck indicates the value is “is midline.” The selections just describedwould lead to the saving of the Key/Value pair at the Class ObjectProperty level, the XML representation level and the database level. Ifthis note were to be recalled from the database, “Key/Value” pair couldrecreate the annotation through interpretation by the computer code.

In software relational database development and structured noteconfiguration, each row has a unique identifier often referred to as theprimary key. Each column of the table is an attribute of the primarykey. If the primary key is related to a row in another table one of thecolumns will contain a pointer to that row and this is known as theforeign key.

The primary and foreign key together is a type key/value pair as are thedescriptors for the rows, such as “Trachea/is midline” in the precedingexample. These concepts can have an image synonym or a location on animage synonym. The interchangeable nature of the image and imagelocation synonyms is one of the unique feature of this invention. Theprimary and foreign keys can both be represented with language or visualimage descriptors and they are interchangeable.

Another example of selection of a Parameter/Key and Value/ChartedObservation is shown in FIG. 4. In this example, the medical conceptshown in the image is the Heart. The user moves the cursor over theaortic valve area of the image and selects a portion of the image, inthis example selects the key of “aortic valve auscultation” or simply“aortic valve.” In response, the text “aortic valve” appears in thewindow 120 of the text box 102 indicating this selection. Furthermore,selection of the parameter” aortic valve” causes a set of images 130 onthe left hand side of the display to be presented. These images 130provide a menu of possible values or charted observations for theselected parameter/key “aortic valve”, and in this example the images132, 134, 136 and 138 represent different types of murmurs. Referring toFIG. 5, the first image 132 in the set or series 130 is selected asindicated by the cursor position 104 by clicking, and then languagedescription shown at 140 is written to the form. The languagedescription correlates with the database row associated with theselected parameter Aortic Valve. The database row contains a uniqueidentifier for image 132, for example a textual description for asystolic crescendo/decrescendo murmur that begins shortly after thefirst heart sound (closure of the mitral and tricuspid valves), reachesa peak in volume just after mid-systole (ejection of the blood from theleft ventricle into the aorta) and tapers off in late systole before thesecond heart sound (closure of the aortic and pulmonary valves). Thisimage 132 demonstrates a pathologic condition of the aortic valve. Thisexample demonstrates the extraordinary efficiency of a small image (132)to convey and very large and complex physiologic concept, and the simpleact of selecting such an image shortening the time needed to enterassociated information into a medical document. Instead of the physicianhaving to type this concept (or dictate it), the physician can simplyselect the image and move on to recording other observations regardingthe patient.

Just as the images 130 come from a finite selection of abnormalfindings, the language descriptions of these abnormalities are alsofinite in number and have a one to one correlation with the images.Therefore, the image and its language descriptor relate to a uniquecompound concept represented by a Key/Value pair.

The Key of a Key/Value pair (such as the Aortic Valve in FIGS. 4 and 5or the Trachea in FIG. 3) will have different values depending on thepatient answers or clinician observations.

On the charting forms (such as for example the charting form or templateshown in FIGS. 3-5) the keys are represented by images or portionsthereof, as are the values. In one example, selecting an image (orportion thereof) to indicate selection of a key, such as the Trachea, orAortic Valve, causes the appearance of one or more selectable images(130). Selecting an image in the set of images 130 creates one key/valuepair, e.g., Aortic Valve/systolic diamond shaped murmur in the exampleof FIG. 5.

A structured medical note is typically made of many key/value pairs. Anexample of how a structured medical note consisting of many key/valuepairs is constructed will be demonstrated in FIG. 6 and the followingfigures. In essence, the selection of parameters/keys and values asdescribed above is repeated as many times as deemed necessary by theuser in order to complete the creation of the note. For example, afterthe selection of the value (image 132) for the aortic valve parameter,the user moves the cursor 104 to another area of the heart as shown inFIG. 6. In this example the user holds the cursor over the mitral valvearea of the heart and clicks the mouse or otherwise selects that portionof the image. The text box 102 now displays “mitral valve”, indicatingthe selection of mitral valve as the key/parameter. In response, a newset of images 130 is displayed on the display, each one of the images150, 152, 154, 156, 158 associated with a different murmur orobservation (“Value”) associated with the mitral valve. In this example,and with reference to FIG. 7, the user selected the image 150. Thisimage is a synonym for a text-based representation of a particularmitral valve murmur, in this example a mid-systolic click followed by a2/6 late systolic crescendo murmur. The selection of image causes theadditional text shown at 160 to be added to the medical note. (Dependingon space constraints and the user interface design, the text shown inthe text box 102 may be a complete rendering of the textual synonymassociated with the selected image 150, or it may be a shorthand orabbreviation of that textual synonym. In the case of an abbreviation,the display may include a feature by which the user can see displayedthe entire text corresponding to the image, such as a link or an iconwhich when selected causes a window to pop up that displays the entiretext).

Continuing on with FIG. 8, the user has now moved the cursor over thetriscuspid valve area of the heart and clicked the mouse, therebyindicating selection of the tricuspid valve as the next Key in aKey/Value pair. The selection of the tricuspid valve causes the text“tricuspid valve” to appear in the window 120, confirming the selectionto the user. At this point, two new images appear in the area 130representing potential Values for this Key. The images 170 and 172represent two murmur types associated with the tricuspid valve.Referring to FIG. 9, the user moves the cursor over to the image 170 andclicks it to indicate selection. The text associated with the image 170now appears in the text box 102.

Referring now to FIG. 10, the user has proceeded to move the cursor 104over to the pulmonary valve portion of the heart image and selected itby clicking the mouse. The text “pulmonary valve” now appears in thewindow 120. The selection of this Parameter/Key causes a new set ofimages 190, 192, 194 and 196 to be displayed, each one associated withdifferent potential values for the selected parameter “pulmonary valve.”Referring to FIG. 11, the user selects image 190 by moving the cursor104 to the location of the image and clicking the mouse, which causesthe textual description 200 associated with image 190 to appear in thetext box 102 (“2/6 systolic diamond shaped murmur”).

The process described above can of course continue further, by the userselecting additional portions of the image of the body or the heart tosignify selection of different parameters and then selecting one of theimages associated with different values for the selected parameter.Additional tools for going back, saving, editing, selection of differentorgan systems, and so on are not shown but can of course be part of theuser interface design, and these details are considered within theability of persons skilled in the art.

In the software code, in one possible embodiment the key/value pairs arerepresented as class objects, class members, properties and propertyvalues. More than one class object may be defined as part of the codingprocess. If a note has been started and saved but not finalized, thenote may be opened in an edit mode, in which case the software code willread the key/value pairs from the database or XML document containingthe key/value pairs selected in a prior session, populate the classobjects and property values or XML, and render the form with the imagerepresentation of the saved data.

In some cases, visual charting of key/value pairs will be used todisplay text when the document is rendered to the user. In other cases,the key/value pairs can be used to render charted values displayed orsuperimposed on images. A unique feature the invention is theinterchangeability of the image synonyms and specific image locationswith the language descriptors of the specific concepts.

The recorded, saved and persisted data can be stored in a database, oras a text file with a specific format such as XML. The computer code canbe written in any language capable of rendering a form, reading andwriting to a database and reading or writing to XML or other formattedtext file and creating an object or object like structure in whichmember and properties can be assigned values, methods can be created andobject state can be loaded from a persistent data representation orunloaded to a persistent data representation. An example of such code isset forth below:

TABLE-US-OOOOI Object Oriented Class Class Physical_Exam PrivateCardiac_S1 as string Private Cardiac S2 as string Private Cardiac S3 asstring Private Cardiac S4 as string Private Cardiac Aortic Value asstring Private Cardiac Mitral_Value as string Private Cardiac_TricuspidValue as string Private Cardiac_Pulmonary Value as string PublicProperty pCardiac_S1 as String Get RETURN Cardiac_S1 End Get Set (ByValvalue As String) Cardiac S1=value End Set . . . End Class

There are many potential commercial use(s) for the invention: HospitalClinician Charting; Medical Office Clinician Charting; Long-term carefacility Clinician Charting; Nursing Home Clinician Charting;Rehabilitation facility Clinician Charting; and Clinician Charting onMobile User Interface Platforms, including smart phones, iPhones, iPads,Pocket PCs, or any other mobile device used for medical charting.Additionally, the computer device used for medical charting can includelaptop computers, tablet computers and fixed workstations. The inventionis suitable for touch screen user interface systems. In general, anycomputing device having a processing unit, a memory storing softwarecomputer instructions and a user interface adapted for medical chartingagainst an electronic medical record can be used.

In view of the above description, it will be appreciated that a methodof creating a medical document using a computing device (14/17) having adisplay using visual charting has been described, comprising the stepsof:

(a) presenting on the display (FIG. 4) an image representing a medicalconcept, such as an organ or organ system of a human or animal body(e.g., the heart in FIG. 4);

(b) enabling selection of a parameter associated with the medicalconcept by selecting a portion of the image corresponding to theparameter (e.g., selection of the parameter “aortic valve” in FIG. 4);

(c) responsive to the selecting in step (b), presenting on the display aset of images (130, FIG. 4) comprising possible values associated withselected parameter;

(d) enabling selection one of the images in the set of images presentedin step (c) (selection occurring by clicking the cursor while the cursoris over the image as shown in FIG. 5, or by means of touching the imagein a touch sensitive display embodiment); and

(e) constructing a medical document based on the selecting in steps (b)and step (d) (see FIG. 4, text box 102) and storing the medical documentin a computer system (FIG. 1, e.g., in the database 18) wherein theimages selected in steps (b) and (d) are interchangeable with a languagedescription of the selected parameter and the selected value of theselected parameter.

It will further be appreciated from the foregoing description that a newand improved computing device for visual charting has been described.The computing device (FIG. 1, 14, or 17) has a display (FIG. 4), andmemory, not shown but conventional) storing instructions for executionby a processing unit (not shown, but conventional) in the device. Theimprovement takes the form of a visual charting application coded as aset of instructions executed by the device, described by way of examplein FIGS. 4-11), wherein creation of a medical document by the visualcharting application is performed by selection of images presented onthe display of the computing device, the images including images of afirst type acting as a synonym for a medical parameter (e.g., the imageof the heart or a portion thereof corresponding to a particular valve)and images of a second type (images 130 in FIGS. 4-11) acting assynonyms of values of the medical parameter, wherein a selection by theuser of an image of the first type (selection of aortic valve in FIG. 4)causing a display of a set of images of the second type to be presentedon the display (FIG. 4, images 132, 134, 136 and 138).

In still another aspect, a method of creating electronic medicaldocuments has been described comprising the steps of:

creating a data structure (e.g., XML document) with persistent datacomprising descriptive information associated with a plurality images tobe presented on a medical documentation template displayed on acomputing device, the images representing medical concepts such as anorgan or organ system of a human or animal body;

rendering one of the images in the medical documentation template on thecomputing device (FIG. 4);

receiving a user selection on the computing device of a parameter of themedical concept by selecting a feature in the image corresponding to theparameter (FIG. 4, selection of “aortic valve” feature of the heartimage);

responsively displaying on the display a set of images associated withvalues of the selected parameter (display of images 132, 134, 136, 138,FIG. 4);

receiving a selection of one of the images in the set of images (FIG. 5,clicking on the image 132); and

creating a medical document reflecting the selection of the images andstoring the medical document in a database (FIG. 1, 18).

While a number of exemplary aspects and embodiments have been discussedabove, those of skill in the art will recognize that variousmodifications, permutations, and additions are possible. It is thereforeintended that the following appended claims and claims hereafterintroduced are interpreted to include all such modifications,permutations, additions and sub-combinations as are within their truespirit and scope.

What is claimed is:
 1. A processing device for specifying medicalinformation pertaining to a patient in an electronic medical record in amedical health care computer system, comprising: a display; a memory,operatively coupled to the display; a processor, operatively coupled tothe memory; and a communications interface for communicating with thehealth care computer system; wherein the processor is configured to (i)generate for the display an anatomical image representing arepresentation of a body, (ii) receive a first user input of a firstparameter associated with a portion of the generated anatomical imagecorresponding to the parameter, (iii) generate for the display a set ofimages on the display comprising values associated with the first userinput of the first parameter, wherein at least one of the set ofgenerated images represent different values associated with a body partof the anatomical image and uniquely represents a first predefinedtextual description of medical information, (iv) receive a second userinput representing a selection of one of the set of images, (v) generatea structured note comprising an interchangeable primary key and foreignkey configured as at least one key/value pair associated with the firstuser input corresponding to the first predefined textual description andsecond user input selecting one of the set of images; and (vi)electronically communicate, via the communications interface, thestructured note to a server for use in processing the electronic medicalrecord.
 2. The processing device of claim 1, wherein the processor isconfigured to generate a medical document that is stored in associationwith an electronic medical record of the patient, the medical documentcomprising the data representing the first predefined specifiedpredefined textual description of medical information pertaining to thepatient.
 3. The processing device of claim 1, wherein the processor isconfigured to update a medical document that is stored in associationwith an electronic medical record of the patient, the medical documentcomprising the data representing the first predefined specifiedpredefined textual description of medical information pertaining to thepatient.
 4. The processing device of claim 1, wherein the processor isconfigured to save medical information pertaining to the patient that isspecified by the user as a text file in a predetermined format.
 5. Theprocessing device of claim 4, wherein the predetermined format comprisesan XML format.
 6. The processing device of claim 4, wherein the medicalinformation pertaining to the patient that is specified by the user issaved as a key/value pair in a database.
 7. The processing device ofclaim 1, wherein the processor is configured to save the first userinput as properties of a class object in an object-oriented system. 8.The processing device of claim 1, wherein the anatomical image comprisesan organ or organ system comprising at least two of a heart, acirculatory system, a respiratory system, kidneys, a digestive system, askeletal system and a central nervous system.
 9. The processing deviceof claim 1, wherein the processor is configured to electronicallycommunicate wirelessly over a cellular network.
 10. The processingdevice of claim 1, wherein the processor is configured to electronicallycommunicate over the Internet.
 11. A method for specifying medicalinformation pertaining to a patient in an electronic medical record in amedical health care computer system, comprising: generating, via aprocessing device, an anatomical image for a display, representing arepresentation of a body; receiving, via the processing device, a firstuser input of a first parameter associated with a portion of thegenerated anatomical image corresponding to the parameter; generating,via the processing device, a set of images on the display comprisingvalues associated with the first user input of the first parameter,wherein at least one of the set of generated images represent differentvalues associated with a body part of the anatomical image and uniquelyrepresents a first predefined textual description of medicalinformation; receiving, via the processing device, a second user inputrepresenting a selection of one of the set of images; generating astructured note comprising an interchangeable primary key and foreignkey configured as at least one key/value pair associated with the firstuser input corresponding to the first predefined textual description andsecond user input selecting one of the set of images; and electronicallycommunicating, via the processing device to a communications interface,the structured note to a server for use in processing the electronicmedical record.
 12. The method of claim 10, further comprisinggenerating a medical document that is stored in association with anelectronic medical record of the patient, the medical documentcomprising the data representing the first predefined specifiedpredefined textual description of medical information pertaining to thepatient.
 13. The method of claim 10, further comprising updating amedical document that is stored in association with an electronicmedical record of the patient, the medical document comprising the datarepresenting the first predefined specified predefined textualdescription of medical information pertaining to the patient.
 14. Themethod of claim 10, further comprising saving to a memory medicalinformation pertaining to the patient that is specified by the user as atext file in a predetermined format.
 15. The method of claim 14, whereinthe predetermined format comprises an XML format.
 16. The method ofclaim 14, wherein the medical information pertaining to the patient thatis specified by the user is saved as a key/value pair in a database. 17.The method of claim 10, further comprising saving, via the processingdevice, the first user input in a memory as properties of a class objectin an object-oriented system.
 18. The method of claim 10, wherein theanatomical image comprises an organ or organ system comprising at leasttwo of a heart, a circulatory system, a respiratory system, kidneys, adigestive system, a skeletal system and a central nervous system. 19.The method of claim 10, wherein electronically communication dataassociated with the first and second user input comprises electronicallycommunicating wirelessly over a cellular network.
 20. A processingdevice for specifying medical information pertaining to a patient in anelectronic medical record in a medical health care computer system,comprising: a display; a memory, operatively coupled to the display; aprocessor, operatively coupled to the memory; and a communicationsinterface for communicating with the health care computer system;wherein the processor is configured to (i) generate for the display ananatomical image representing a representation of a body, (ii) receive afirst user input of a first parameter associated with a portion of thegenerated anatomical image corresponding to the parameter, (iii)generate for the display a set of images on the display comprisingvalues associated with the first user input of the first parameter,wherein at least one of the set of generated images represent differentvalues associated with a body part of the anatomical image and uniquelyrepresents a first predefined textual description of medicalinformation, (iv) receive a second user input representing a selectionof one of the set of images, (v) generate a structured note comprisingan interchangeable primary key and foreign key configured as at leastone key/value pair structure of class objects representing medicalcharacteristics associated with the first user input corresponding tothe first predefined textual description and second user input selectingone of the set of images; and (vi) electronically communicate, via thecommunications interface, the structured note to a server for use inprocessing the electronic medical record.